Estimating severity of sideways fall using a generic multi linear regression model based on kinematic input variables

Many research groups have studied fall impact mechanics to understand how fall severity can be reduced to prevent hip fractures. Yet, direct impact force measurements with force plates are restricted to a very limited repertoire of experimental falls. The purpose of this study was to develop a generic model for estimating hip impact forces (i.e. fall severity) in in vivo sideways falls without the use of force plates.Twelve experienced judokas performed sideways Martial Arts (MA) and Block (‘natural’) falls on a force plate, both with and without a mat on top. Data were analyzed to determine the hip impact force and to derive 11 selected (subject-specific and kinematic) variables. Falls from kneeling height were used to perform a stepwise regression procedure to assess the effects of these input variables and build the model.The final model includes four input variables, involving one subject-specific measure and three kinematic variables: maximum upper body deceleration, body mass, shoulder angle at the instant of ‘maximum impact’ and maximum hip deceleration. The results showed that estimated and measured hip impact forces were linearly related (explained variances ranging from 46 to 63%). Hip impact forces of MA falls onto the mat from a standing position (3650 ± 916 N) estimated by the final model were comparable with measured values (3698 ± 689 N), even though these data were not used for training the model. In conclusion, a generic linear regression model was developed that enables the assessment of fall severity through kinematic measures of sideways falls, without using force plates.     

The effect of surface area digitizations on the prediction of spherical anatomical geometries for computer-assisted applications

Intraoperative digitization of osseous structures is an integral component of computer-assisted orthopaedic surgery. This study determined the repeatability and accuracy of predicting known radii and center locations of spherical objects for different proportions of digitized surface areas and various sphere sizes. Also, we investigated these accuracies for some relevant near-spherical osseous structures where results from full area digitizations were considered to be true. Digitizations were performed using an electromagnetic tracker with a stylus on the total and fractional surfaces of 10 hemispheres, ranging from 10 to 28 mm in radius. Repeatability was quantified by digitizing five trials of the entire surface and various fractional areas of selected hemisphere sizes. Similar trials were conducted on models of a humeral and femoral head, using the full head area as baseline and digitizing 15 and 30 mm diameter areas of the full head. Mean error for the predicted radii and center positions of the hemispheres ranged from 0.39±0.29 to 0.14±0.07 mm and 0.52±0.31 to 0.22±0.12 mm, respectively. Repeatability for the predicted radii and centers produced maximum standard deviations of 0.31 and 0.42 mm, respectively. All errors decreased as fractional area (40%, 60%, 80% and 100%) increased (p<0.05). Radius of curvature and center position errors for the humeral head model were 1.51±2.11 and 2.28±1.51 mm, respectively. These errors for the femoral head model were 3.37±4.14 and 4.25±4.14 mm, respectively. Errors resulting from the prediction of radius and center indicate that non-spherical anatomical structures are more sensitive to the digitized area, and hence digitization of the largest surface possible seems warranted.     

Prediction of joint center location by customizable multiple regressions: Application to clavicle,scapula and humerus

Accurate spatial location of joint center (JC) is a key issue in motion analysis since JC locations are used to define standardized anatomical frames, in which results are represented. Accurate and reproducible JC location is important for data comparison and data exchange. This paper presents a method for JC locations based on the multiple regression algorithms without preliminary assumption on the behavior of the joint-of-interest. Regression equations were obtained from manually palpable ALs on each bone-of-interest. Results are presented for all joint surfaces found on the clavicle, scapula and humeral bone. Mean accuracy errors on the JC locations obtained on dry bones were 5.2±2.5 mm for the humeral head, 2.5±1.1 mm for the humeral trochlea, 2.3±0.9 mm for the humeral capitulum, 8.2±3.9 mm for the scapula glenoid cavity, 7.2±3.2 mm for the scapular aspect of the acromio-clavicular joint, 3.5±1.8 mm for the clavicular aspect of the sternoclavicular joint and 3.2±1.4 mm for the clavicular aspect of the acromio-clavicular joint. In-vitro and in-vivo validation accuracy was 5.3 and 8.5 mm, respectively, for the humeral head center location. Regression coefficients for joint radius dimension and joint surface orientation were also processed and reported in this paper.     

The effect of positioning on the biomechanical performance of soft shell hip protectors

Wearable hip protectors represent a promising strategy for reducing risk for hip fracture from a sideways fall. However, small changes in pad positioning may influence their protective benefit. Using a mechanical hip impact simulator, we investigated how three marketed soft shell hip protectors attenuate and redistribute the impact force applied to the hip, and how this depends on displacement from their intended position by 2.5 or 5 cm superiorly, posteriorly, inferiorly or anteriorly. For centrally-placed protectors, peak pressure was reduced 93% below the unpadded value by a 16 mm horseshoe-shaped protector, 93% by a 14 mm horseshoe protector, and 94% by a 16 mm continuous protector. In unpadded trials, 83% of the total force was applied to the skin overlying the proximal femur (danger zone). This was lowered to 19% by the centrally placed 16 mm horseshoe protector, to 34% by the 14 mm horseshoe, and to 40% by the 16 mm continuous protector. Corresponding reductions in peak force delivered to the femoral neck (relative to unpadded) were 45%, 38%, and 20%, respectively. The protective benefit of all three protectors decreased with pad displacement. For example, displacement of protectors by 5 cm anteriorly caused peak femoral neck force to increase 60% above centrally-placed values, and approach unpadded values. These results indicate that soft shell hip protectors provide substantial protective benefits, but decline in performance with small displacements from their intended position. Our findings confirm the need for correct and stable positioning of hip protectors in garment design.     

Changes in force and tendinous tissue elongation during the early phase of tetanic summation in in vivo human tibialis anterior muscle

The purpose of this study was to determine the changes that occur in tendinous tissue properties during the early phase of tetanic summation in the in vivo human tibialis anterior muscle (TA). The torque response and tendinous tissue elongation following single stimuli, two-pulse trains, and three-pulse trains were recorded in the TA during isometric contractions. The elongation, compliance, and lengthening velocity of tendinous tissue were determined by real-time ultrasonography. The contribution of the response to the second stimulation (C2) was obtained by subtracting the response to the single stimulation (C1) from the response of doublet. The third contribution (C3) was obtained by subtracting the response to the doublet from that of the triplet. C2 (7.8±0.5 Nm) and C3 (7.3±0.6 Nm) had torque responses significantly higher than C1 (3.6±0.7 Nm). In contrast, the elongations of tendinous tissue for C2 (2.8±0.4 mm) and C3 (1.7±0.2 mm) were significantly lower than for C1 (4.9±0.3 mm), indicating that the summation pattern of tendinous tissue elongation is different from the summation pattern of torque response. In addition, this showed considerable difference both between C1 (0.12±0.01 mm/N; 83±4.6 mm/s) and C2 (0.03±0.005 mm/N; 50±6.3 mm/s) and between C1 and C3 (0.02±0.002 mm/N; 39±6.4 mm/s) in the compliance and lengthening velocity of tendinous tissue. These results suggest that changes in tendinous tissue properties between first and second contraction are related to different summation patterns of force and tendinous tissue elongation during early phase of tetanic summation.     

Mechanical properties of the patellar tendon in adults and children

It is not currently known how the mechanical properties of human tendons change with maturation in the two sexes. To address this, the stiffness and Young's modulus of the patellar tendon were measured in men, women, boys and girls (each group, n=10). Patellar tendon force (F_pt) was calculated from the measured joint moment during a ramped voluntary isometric knee extension contraction, the antagonist knee extensor muscle co-activation quantified from its electromyographical activity, and the patellar tendon moment arm measured from magnetic resonance images. Tendon elongation was imaged using the sagittal-plane ultrasound scans throughout the contraction. Tendon cross-sectional area was measured at rest from ultrasound scans in the transverse plane. Maximal F_pt and tendon elongation were (mean±SE) 5453±307 N and 5±0.5 mm for men, 3877±307 N and 4.9±0.6 mm for women, 2017±170 N and 6.2±0.5 mm for boys and 2169±182 N and 5.9±0.7 mm for girls. In all groups, tendon stiffness and Young's modulus were examined at the level that corresponded to the maximal 30% of the weakest participant's F_pt and stress, respectively; these were 925–1321 N and 11.5–16.5 MPa, respectively. Stiffness was 94% greater in men than boys and 84% greater in women than girls (p<0.01), with no differences between men and women, or boys and girls (men 1076±87 N/mm; women 1030±139 N/mm; boys 555±71 N/mm and girls 561.5±57.4 N/mm). Young's modulus was 99% greater in men than boys (p<0.01), and 66% greater in women than girls (p<0.05). There were no differences in modulus between men and women, or boys and girls (men 597±49 MPa; women 549±70 MPa; boys 255±42 MPa and girls 302±33 MPa). These findings indicate that the mechanical stiffness of tendon increases with maturation due to an increased Young's modulus and, in females due to a greater increase in tendon cross-sectional area than tendon length.     

Multi-institutional comparison of simulated treatment delivery errors in ssIMRT,manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy

PurposeTo quantify the impact of simulated errors for nasopharynx radiotherapy across multiple institutions and planning techniques (auto-plan generated Volumetric Modulated Arc Therapy (ap-VMAT), manually planned VMAT (mp-VMAT) and manually planned step and shoot Intensity Modulated Radiation Therapy (mp-ssIMRT)).MethodsTen patients were retrospectively planned with VMAT according to three institution’s protocols. Within one institution two further treatment plans were generated using differing treatment planning techniques. This resulted in mp-ssIMRT, mp-VMAT, and ap-VMAT plans. Introduced treatment errors included Multi Leaf Collimator (MLC) shifts, MLC field size (MLCfs), gantry and collimator errors. A change of more than 5% in most selected dose metrics was considered to have potential clinical impact. The original patient plan total Monitor Units (MUs) were correlated to the total number of dose metrics exceeded.ResultsThe impact of different errors was consistent, with ap-VMAT plans (two institutions) showing larger dose deviations than mp-VMAT created plans (one institution). Across all institutions’ VMAT plans the significant errors included; ±5° for the collimator angle, ±5 mm for the MLC shift and +1, ±2 and ±5 mm for the MLC field size. The total number of dose metrics exceeding tolerance was positively correlated to the VMAT total plan MUs (r = 0.51, p < 0.001), across all institutions and techniques.ConclusionsDifferences in VMAT robustness to simulated errors across institutions occurred due to planning method differences. Whilst ap-VMAT was most sensitive to MLC errors, it also produced the best quality treatment plans. Mp-ssIMRT was most robust to errors. Higher VMAT treatment plan complexity led to less robust plans.     

Electromyographic,but not mechanomyographic amplitude–force relationships,distinguished differences in voluntary activation capabilities between individuals

The purpose of the present study was to examine the influence of activation capabilities on the electromyography (EMG_RMS) and mechanomyography amplitude (MMG_RMS)–force relationships of the vastus lateralis (VL) and rectus femoris (RF). Thirteen men (mean ± SD; age = 22 ± 3 year) performed nine submaximal contractions (10–90% maximal voluntary contraction [MVC]) with the interpolated twitch technique performed during a separate contraction at 90% MVC to calculate percent voluntary activation (%VA). Nine participants with >90% VA were categorized into the high-activated group with the remaining categorized into the moderate-activated group. Slopes (b terms) were calculated from the log-transformed EMG_RMS and MMG_RMS–force relationships. The b terms (collapsed across the VL and RF) for the EMG_RMS–force relationships were greater for the high- (1.29 ± 0.31) than the moderate-activated (1.10 ± 0.20) group. In contrast, there were no differences in the b terms for the MMG_RMS–force relationships between the high- and moderate-activated groups. For the EMG_RMS and MMG_RMS–force relationships, the b terms were greater for the RF (1.38 ± 0.30, 0.81 ± 0.20) than the VL (1.08 ± 0.19, 0.60 ± 0.13) collapsed across groups. The b terms from the EMG_RMS–force relationships, but not the MMG_RMS–force relationships, reflected differences in %VA.     

The role of a cleft upper lip of alpacas in foraging extremely short grasses evaluated by grazing impulse

The role of a cleft upper lip of alpaca (Lama pacos) in foraging short pastures was investigated using biting forces and associated impulses in animal grazing. Three Merino wethers and three castrated alpacas were used. Ten (10L), 20 (20L), 30 (30L), 40 (40L) or 50 (50L) leaves of orchardgrass (Dactylis glomerata) per load cell were offered to animals, and three-directional biting forces were digitally recorded at 5 s⁻¹⁰⁰⁰. From the total biting force/time curve, grazing impulse was calculated, equivalent to the area surrounded by the curve. The grand mean of the number of grazed leaves per bite was 9.8 ± 0.53 in alpaca and 17.9 ± 1.31 in sheep. Remaining leaf length after grazing trial was significantly lower in alpaca than in sheep (11.9 ± 0.19 mm versus 18.5 ± 0.41 mm). Alpaca grazed leaves with significantly lower mean biting force (7.0 ± 0.69 N versus 20.0 ± 1.80 N) and significantly shorter duration time per one biting force (0.11 ± 0.005 s versus 0.18 ± 0.19 s) than sheep. The grand mean of sum of grazing impulse was lower (P < 0.002) in alpaca (2.8 ± 0.42 N s) than in sheep (9.4 ± 1.95 N s). Grazed DM weight increased with increasing leaf densities, but there was no difference between alpaca and sheep. The ratio of DM intake to grazing impulse was significantly higher in alpaca than in sheep (0.18 ± 0.016 g DM/N s versus 0.08 ± 0.010 g DM/N s). The grazing strategy in alpaca seems to be an adaptation for foraging extremely short grasses. Alpacas may push aside cleft upper lips when trying to grasp short leaves, resulting in keeping incisors at lower insertion position near the ground surface.     

EMG normalization to study muscle activation in cycling

The value of electromyography (EMG) is sensitive to many physiological and non-physiological factors. The purpose of the present study was to determine if the torque–velocity test (T–V) can be used to normalize EMG signals into a framework of biological significance. Peak EMG amplitude of gluteus maximus (GMAX), vastus lateralis (VL), rectus femoris (RF), biceps femoris long head (BF), gastrocnemius medialis (GAS) and soleus (SOL) was calculated for nine subjects during isometric maximal voluntary contractions (IMVC) and torque–velocity bicycling tests (T–V). Then, the reference EMG signals obtained from IMVC and T–V bicycling tests were used to normalize the amplitude of the EMG signals collected for 15 different submaximal pedaling conditions. The results of this study showed that the repeatability of the measurements between IMVC (from 10% to 23%) and T–V (from 8% to 20%) was comparable. The amplitude of the peak EMG of VL was 99 ± 43% higher (p < 0.001) when measured during T–V. Moreover, the inter-individual variability of the EMG patterns calculated for submaximal cycling exercises differed significantly when using T–V bicycling normalization method (GMAX: 0.33 ± 0.16 vs. 1.09 ± 0.04, VL: 0.07 ± 0.02 vs. 0.64 ± 0.14, SOL: 0.07 ± 0.03 vs. 1.00 ± 0.07, RF: 1.21 ± 0.20 vs. 0.92 ± 0.13, BF: 1.47 ± 0.47 vs. 0.84 ± 0.11). It was concluded that T–V bicycling test offers the advantage to be less time and energy-consuming and to be as repeatable as IMVC tests to measure peak EMG amplitude. Furthermore, this normalization method avoids the impact of non-physiological factors on the amplitude of the EMG signals so that it allows quantifying better the activation level of lower limb muscles and the variability of the EMG patterns during submaximal bicycling exercises.     

Identification of rupture locations in patient-specific abdominal aortic aneurysms using experimental and computational techniques

In the event of abdominal aortic aneurysm (AAA) rupture, the outcome is often death. This paper aims to experimentally identify the rupture locations of in vitro AAA models and validate these rupture sites using finite element analysis (FEA). Silicone rubber AAA models were manufactured using two different materials (Sylgard 160 and Sylgard 170, Dow Corning) and imaged using computed tomography (CT). Experimental models were inflated until rupture with high speed photography used to capture the site of rupture. 3D reconstructions from CT scans and subsequent FEA of these models enabled the wall stress and wall thickness to be determined for each of the geometries. Experimental models ruptured at regions of inflection, not at regions of maximum diameter. Rupture pressures (mean±SD) for the Sylgard 160 and Sylgard 170 models were 650.6±195.1 mmHg and 410.7±159.9 mmHg, respectively. Computational models accurately predicted the locations of rupture. Peak wall stress for the Sylgard 160 and Sylgard 170 models was 2.15±0.26 MPa at an internal pressure of 650 mmHg and 1.69±0.38 MPa at an internal pressure of 410 mmHg, respectively. Mean wall thickness of all models was 2.19±0.40 mm, with a mean wall thickness at the location of rupture of 1.85±0.33 and 1.71±0.29 mm for the Sylgard 160 and Sylgard 170 materials, respectively. Rupture occurred at the location of peak stress in 80% (16/20) of cases and at high stress regions but not peak stress in 10% (2/20) of cases. 10% (2/20) of models had defects in the AAA wall which moved the rupture location away from regions of elevated stress. The results presented may further contribute to the understanding of AAA biomechanics and ultimately AAA rupture prediction.     

Objective assessment of the cryoprotective effects of dimethylformamide for freezing goat semen

The aim of this work was to assess the cryoprotective effects of dimethylformamide (DMF) for freezing goat semen, using an objective analysis by computer-assisted sperm analysis (CASA). Twenty-one ejaculates (seven per animal) were collected from three stud bucks with the aid of an artificial vagina and immediately evaluated for gross and microscopic characteristics. The semen was diluted in two steps with a Tris–egg yolk extender containing 6% glycerol or 6% DMF, frozen in 0.50-mL straws, and stored in liquid nitrogen. Samples were accessed for sperm morphology, sperm membrane structural and functional integrity, and by CASA, immediately after thawing. There were differences (P < 0.05) between glycerol and DMF with regard to subjective progressive motility (23.9 ± 2.2% vs. 16.6 ± 2.0%), objective progressive motility (3.5 ± 0.4% vs. 1.8 ± 0.3%), linearity (53.9 ± 1.6% vs. 48.1 ± 1.4%) and amplitude of lateral head (2.3 ± 0.1 vs. 2.9 ± 0.1 mm), which confirmed the efficiency of glycerol. In conclusion, dimethylformamide could be used as an alternative cryoprotectant for goat semen freezing. However it was showed that no benefits were derived by using dimethylformamide to replace glycerol at an equal 6% concentration.     

Dynamic in vivo 3D atlantoaxial spine kinematics during upright rotation

Diagnosing dysfunctional atlantoaxial motion is challenging given limitations of current diagnostic imaging techniques. Three-dimensional imaging during upright functional motion may be useful in identifying dynamic instability not apparent on static imaging. Abnormal atlantoaxial motion has been linked to numerous pathologies including whiplash, cervicogenic headaches, C2 fractures, and rheumatoid arthritis. However, normal C1/C2 rotational kinematics under dynamic physiologic loading have not been previously reported owing to imaging difficulties. The objective of this study was to determine dynamic three-dimensional in vivo C1/C2 kinematics during upright axial rotation. Twenty young healthy adults performed full head rotation while seated within a biplane X-ray system while radiographs were collected at 30 images per second. Six degree-of-freedom kinematics were determined for C1 and C2 via a validated volumetric model-based tracking process. The maximum global head rotation (to one side) was 73.6 ± 8.3°, whereas maximum C1 rotation relative to C2 was 36.8 ± 6.7°. The relationship between C1/C2 rotation and head rotation was linear through midrange motion (±20° head rotation from neutral) in a nearly 1:1 ratio. Coupled rotation between C1 and C2 included 4.5 ± 3.1° of flexion and 6.4 ± 8.2° of extension, and 9.8 ± 3.8° of contralateral bending. Translational motion of C1 relative to C2 was 7.8 ± 1.5 mm ipsilaterally, 2.2 ± 1.2 mm inferiorly, and 3.3 ± 1.0 mm posteriorly. We believe this is the first study describing 3D dynamic atlantoaxial kinematics under true physiologic conditions in healthy subjects. C1/C2 rotation accounts for approximately half of total head axial rotation. Additionally, C1 undergoes coupled flexion/extension and contralateral bending, in addition to inferior, lateral and posterior translation.     

Effect of kinesthetic illusion induced by visual stimulation on muscular output function after short-term immobilization

Kinesthetic illusions by visual stimulation (KiNVIS) enhances corticomotor excitability and activates motor association areas. The purpose of this study was to investigate the effect of KiNVIS induction on muscular output function after short-term immobilization. Thirty subjects were assigned to 3 groups: an immobilization group, with the left hand immobilized for 12 h (immobilization period); an illusion group, with the left hand immobilized and additionally subjected to KiNVIS of the immobilized part during the immobilization period; and a control group with no manipulation. The maximum voluntary contraction (MVC), fluctuation of force (force fluctuation) during a force modulation task, and twitch force were measured both before (pre-test) and after (post-test) the immobilization period. Data were analyzed by performing two-way (TIME × GROUP) repeated measures ANOVA. The MVC decreased in the immobilization group only (pre-test; 37.8 ± 6.1 N, post-test; 32.8 ± 6.9 N, p < 0.0005) after the immobilization period. The force fluctuation increased only in the immobilization group (pre-test; 2.19 ± 0.54%, post-test; 2.78 ± 0.87%, p = 0.007) after the immobilization period. These results demonstrate that induction of KiNVIS prevents negative effect on MVC and force fluctuation after 12 h of immobilization.     

Lower limb joint work and joint work contribution during downhill and uphill walking at different inclinations

Work performance and individual joint contribution to total work are important information for creating training protocols, but were not assessed so far for sloped walking. Therefore, the purpose of this study was to analyze lower limb joint work and joint contribution of the hip, knee and ankle to total lower limb work during sloped walking in a healthy population. Eighteen male participants (27.0 ± 4.7 yrs, 1.80 ± 0.05 m, 74.5 ± 8.2 kg) walked on an instrumented ramp at inclination angles of 0°, ±6°, ±12° and ±18° at 1.1 m/s. Kinematic and kinetic data were captured using a motion-capture system (Vicon) and two force plates (AMTI). Joint power curves, joint work (positive, negative, absolute) and each joint’s contribution to total lower limb work were analyzed throughout the stance phase using an ANOVA with repeated measures. With increasing inclination positive joint work increased for the ankle and hip joint and in total during uphill walking. Negative joint work increased for each joint and in total work during downhill walking. Absolute work was increased during both uphill (all joints) and downhill (ankle & knee) walking. Knee joint contribution to total negative and absolute work increased during downhill walking while hip and ankle contributions decreased. This study identified, that, when switching from level to a 6° and from 6° to a 12° inclination the gain of individual joint work is more pronounced compared to switching from 12° to an 18° inclination. The results might be used for training recommendations and specific training intervention with respect to sloped walking.     

Respiratory motion of adrenal gland metastases: Analyses using four-dimensional computed tomography images

PurposeTo evaluate the respiratory motion of adrenal gland metastases in three-dimensional directions using four-dimensional computed tomography (4DCT) images.MethodsFrom January 2013 to May 2016, 12 patients with adrenal gland metastases were included in this study. They all underwent 4DCT scans to assess respiratory motion of adrenal gland metastases in free breathing state. The 4DCT images were sorted into 10 image series according to the respiratory phase from the end inspiration to the end expiration, and then transferred to FocalSim workstation. All gross tumor volumes (GTVs) of adrenal gland metastases were drawn by a single physician and confirmed by a second. Relative coordinates of adrenal gland metastases were automatically generated to calculate adrenal gland metastases motion in different axial directions.ResultsThe average respiratory motion of adrenal gland metastases in left-right (LR), cranial-caudal (CC), anterior-posterior (AP), 3-dimensional (3D) vector directions was 3.4 ± 2.2 mm, 9.5 ± 5.5 mm, 3.8 ± 2.0 mm and 11.3 ± 5.3 mm, respectively. The ratios were 58.6% ± 11.4% and 63.2% ± 12.5% when the volumes of GTV_In0% and GTV _In100% were compared with volume of IGTV_10phase. The volume ratio of IGTV_10phase to GTV_3D was 1.73 ± 0.48.ConclusionsAdrenal gland metastasis is a respiration-induced moving target, and an internal target volume boundary should be provided when designing the treatment plan. The CC motion of adrenal gland metastasis is predominant and >5 mm, thus motion management strategies are recommended for patients undergoing external radiotherapy for adrenal gland metastasis.     

Impaired action potential conduction at high force levels after eccentric exercise

High-density surface electromyography was used to examine whether gross sarcolemmal function is impaired in m. biceps brachii after intensive eccentric elbow flexor exercise, when measured at wide range of isometric contraction levels.Root mean square (RMS), mean power frequency (MNF) and mean muscle fibre conduction velocity (CV) were calculated before and up to four days post-exercise.Maximal isometric voluntary (MVC) force decreased by 21.3 ± 5.6% two hours after exercise, and by 12.6 ± 11.1% two days post-exercise. CV and MNF decreased both during MVC (CV from 4.1 ± 0.3 m/s to 3.8 ± 0.4 m/s and MNF from 92.6 ± 10 Hz to 85.2 ± 11 Hz) and during electrically evoked maximal M-wave (CV from 4.1 ± 0.3 m/s to 3.0 ± 0.5 m/s and MNF from 97.1 ± 27.2 Hz to 78.0 ± 24.4 Hz) two hours post-exercise. Furthermore, at submaximal isometric force levels, CV and MNF decreased only at higher contraction levels (40%, 50% and 75% of MVC) two hour post-exercise.It can be concluded that intensive exercise can temporarily impair gross sarcolemmal function. In addition, since this only occurred at high force levels, based on Henneman’s size principle, it seems that higher threshold motor units were predominantly affected.     

The in vivo assessment of mechanical loadings on pectoral pacemaker implants

Reduced sizes of implantable cardiac pacemakers and clinical advances have led to a higher feasibility of using such devices in younger patients including children. Increased structural demands deriving from reduced device size and more active recipients require detailed knowledge of in vivo mechanical conditions to ensure device reliability. Objective of this study was the proof of feasibility of a system for the measurement of in vivo mechanical loadings on pacemaker implants. The system comprised the following: implantable instrumented pacemaker (IPM) with six force sensors, accelerometer and radio-frequency (RF) transceiver; RF data logging system and video capture system. Three Chacma baboons (20.6±1.15 kg) received one pectoral sub-muscular IPM implant. After wound healing, forces were measured during physical activities. Forces during range of motion of the arm were assessed on the anaesthetized animals prior to device explantation. Mass, volume and dimensions of the excised Pectoralis major muscles were determined after device explantation. Remote IPM activation and data acquisition were reliable in the indoor cage environment with transceiver distances of up to 3 m. Sampling rates of up to 1000 Hz proved sufficient to capture dynamic in vivo loadings. Compressive forces on the IPM in conscious animals reached a maximum of 77.2±54.6 N during physical activity and were 22.2±7.3 N at rest, compared with 34.6±15.7 N maximum during range of motion and 13.4±3.3 N at rest in anaesthetized animals. The study demonstrated the feasibility of the developed system for the assessment of in vivo mechanical loading conditions of implantable pacemakers with potential for use for other implantable therapeutic devices.     

On-site audits to investigate the quality of radiation physics of radiation therapy institutions in the Republic of Korea

PurposeTo investigate and improve the domestic standard of radiation therapy in the Republic of Korea.MethodsOn-site audits were performed for 13 institutions in the Republic of Korea. Six items were investigated by on-site visits of each radiation therapy institution, including collimator, gantry, and couch rotation isocenter check; coincidence between light and radiation fields; photon beam flatness and symmetry; electron beam flatness and symmetry; physical wedge transmission factors; and photon beam and electron beam outputs.ResultsThe average deviations of mechanical collimator, gantry, and couch rotation isocenter were less than 1 mm. Those of radiation isocenter were also less than 1 mm. The average difference between light and radiation fields was 0.9 ± 0.6 mm for the field size of 20 cm × 20 cm. The average values of flatness and symmetry of the photon beams were 2.9% ± 0.6% and 1.1% ± 0.7%, respectively. Those of electron beams were 2.5% ± 0.7% and 0.6% ± 1.0%, respectively. Every institutions showed wedge transmission factor deviations less than 2% except one institution. The output deviations of both photon and electron beams were less than ±3% for every institution.ConclusionsThrough the on-site audit program, we could effectively detect an inappropriately operating linacs and provide some recommendations. The standard of radiation therapy in Korea is expected to improve through such on-site audits.